HomeMy WebLinkAboutBLD2019-00562 Cover Deck - BLD Application - 5/29/2019 hgo�cod MASON COUNTY COMMUNITY SERVICES
�' PERMIT ASSISTANCE CENTER: Permit
.BUILDING•PLANNING•PUBLIC HEALTH.FIRE MARSHAL
615 W.Alder Street,Shelton,WA 98584 RECEIVED
1854 nil
Phone Shelton:(360)427-9670 ext. 352•Fax:(360)427-7798 Phone
- Be/falr.(360)275-4467•Phone Elma:(3604��I N G MAY 2 y ���9
BUILDING PEMIT APPLICATION
615 W. Alder Street
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME: 7)"I i 5 1:c !��'/V NAME:
MAILING ADDRESS: 7-1 MAILING ADDRESS:
CITY: r %I / T t STATE: t /kYZIP: qb,-2 CITY: STATE: ZIP:
PHONE#1: 3 D r�-5�F_, PHONE: CELL:
PHONE#2: ` �, -1 3 EMAIL :
EMAIL: /� 0 i c" Rio ��_ o?C�df([z��1vE �e��� L&I REG # EXP.
PRIMARY CONTACT: OWNER(- CONTRACTOR❑ OTHER❑
NAME_ S'' <, h k l� EMAIL
MAILING ADDRESS CITY STATE ZIP
PHONE CELL
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) ` S �� ��� ZONING
LEGAL DESCRIPTION(Abbreviated) FIRE DISTRICT
SITE ADDRESS 7q I G L1 -- A p -i x;? 1—, i� CITY
DIRECTIONS TO SITE ADDRESS f-//1 12 S 7":/1 n T :TI 1 D l,—s
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NO ly,
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER❑ LAKE❑ RIVER/CREEK ❑ POND ❑ WETLAND ❑ SEASONAL RUNOFF ❑ STREAM ❑
TYPE OF WORK: NEW ❑ ADDITION ❑ ALTERATIONh REPAIR❑ OTHER ❑
USE OF STRUCTURE(Residence,Garage,Cornrnereial Bldg,Etc) I/ t(�-
IS USE: PRIMARY)J SEASONAL❑ NUMBER OF BEDROOMS NUMBER OF BATHROOMS
HEATED STRUCTURE,7 YES(Whole Bldg) ❑ YES(Part[sj of Bldg) ❑ NO S
DESCRIBE WORK 4-,? (r t;x c_K
SQUARE FOOTAGE: (propose+existing)
1 ST FLOOR sq. ft. 2ND FLOOR sq. ft. 3RD FLOOR sq. ft. BASEMENT sq. ft.
DECK _ .q. R. COVERED DECK • q. ft. STORAGE sq. 1t. OTHER sq. ft.
GARAGE sq.ft. Attached❑ Detached❑ CARPORT sq. ft. Attached❑ Detached❑
MANUFACTURE,
D HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE O/ MODEL YEAR LENGTH
WIDTH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC ❑ SEWER[-Z, / NEW ❑ EXISTING ❑
PLUMBING IN STRUCTURE? YES ❑ NOM Ifyes, attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES ❑ NOJA EXISTING SQ.FT.
EXISTING BEDROOMS PROPOSED BEDROOMS TOTAL BEDROOMS
OWNER acknowledges that submission of Inaccurate Information may result in a stop work order or permit revocation.Acknowledgement of such Is by
signature below.I declare that I am the owner and I further declare that I am entitled to receive this permit and to do the work as proposed.I have
obtained permission from all the necessary parties,including any easement holder or parties of interest regarding this project. The owner or legal
representative,represents that the information provided is accurate and grants employees of Mason County access to the above described property
and structure(s)for review and inspection. This permit/application becomes null&void if work or authorized construction is not commenced within 180
days or if construction work is suspended for a period of 180 days.
PROOF OF CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERMIT APPLICATION OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED. (MASON
COUNTY CODE 14.08.42)
`Signature of OWNER(Must be signed by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED D TE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT 1� 74 6t
PLANNING DEPARTMENT 1(1 n
FIRE MARSHAL
PUBLIC HEALTH n
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RECEIVED ��G k FILE
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2019 COPY
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